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Abstract

Background: Coronary artery disease (CAD) remains a leading cause of cardiovascular mortality worldwide. Accurate and early risk stratification is essential to prevent adverse cardiac outcomes. The Agatston score, derived from non-contrast cardiac computed tomography (CT), is widely recognized as a non-invasive surrogate marker for coronary artery calcification (CAC) and overall atherosclerotic burden, aiding in the prediction of cardiovascular events in both symptomatic and asymptomatic patients.
Objective: To evaluate the predictive value of the Agatston score in assessing the severity and progression of CAD and its association with adverse clinical outcomes including myocardial infarction, revascularization, and mortality.
Methods: This cross-sectional study was conducted at Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore, over three months. A total of 95 patients with suspected or known cardiovascular risk factors were enrolled using a non-probability consecutive sampling technique. Each participant underwent non-contrast multidetector CT scanning using Toshiba Aquilion 64-slice CT to calculate Agatston scores for the left main artery (LMA), left anterior descending artery (LADA), and left circumflex artery (LCA). Coronary artery disease severity was evaluated through CT coronary angiography. Statistical analysis was performed using SPSS version 25. Continuous variables were reported as mean ± SD, and categorical variables as frequencies and percentages.
Results: Of the 93 patients analyzed, the mean age was 56.04 ± 9.19 years (range 33–78); 72 (77.4%) were male and 21 (22.6%) female. Hypertension and diabetes were present in 60.2% and 55.9% of patients, respectively. The mean Agatston scores were: LMA – 16.41, LADA – 135.67, LCA – 106.70, and total score – 364.83. Median total score was 198.00, with a range from 1.0 to 1797.0. Severity distribution indicated 35.5% mild, 33.3% moderate, and 31.2% severe calcification patterns.
Conclusion: The Agatston score demonstrated a strong predictive value for CAD severity and clinical outcomes. Incorporating CAC scoring in standard cardiac evaluations may improve early detection, enhance risk stratification, and guide more tailored treatment approaches.